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� ��\ry 1�� <br /> � APRLiC�TION FQR CONSTR`�CTiON <br /> � �PE�MIT <br /> "f fhe Cverpreen <br /> CITM OF everett <br /> �� everett � <br /> ; BUILDING DEPARI'MENT <br /> j 259•8810 TO BE CONIPLETED IN INK— PLEASE �!IINT il <br /> � UWNEF MAILADURE55 GRV 21P PrWNE � <br /> I <br /> �J� C2osB✓ �� M �s /-✓ � i <br /> �i TENANT 1AAILADORE55 CItY ZIP PNONE ' �i <br /> 1 <br /> � /�000 �. 1� e�t -� �� ..�Lvp ,--„// cn �.r L2�1��;:- 7�.5 or2.�-Z <br /> S �RCHITECTOP�ESIGNEP IdAIL4DOPE5S _ CITY 21P PHONB <br /> :I ^_.RoS.BI�{S /�/ <i� <br /> GENEFALCONiRACTOR MAILADDRESS� CIiY --- ZIP PMONE LIGENSE• <br /> . MEGHAI�ICALWt�TflRCiOF MAILAGJRE55 / Glil' ZIP PI�ONE LICENSE• <br /> �' PLUM61NaCU111pAGTOR MAILRDOFESS CITY ZIP PMONf LILENSF• <br /> � __ ___ <br /> CLA55OF WOAK �� <br /> � NEW ❑ A�DITION ❑ ALTERATION ❑ REPNF ❑ �EMOLITION �� WOODSTOVE/FRPL INSERT ❑ Bl11LDING RELOCATION <br /> TENAN71MPpOVEMENi Ofi INiEPIOR PEIAO�EL ONLY WNTAGT PERSON ANO PHJNE NO. <br /> ',j CONTPP.^.TPflICEOP WORK _ C f�✓G �� �' /Z n S ,O � 7 �J ^OiZ J� <br /> � �ESGRIbEWOPKANUSOUAREF00iA"'INVOLVED p� ,� <br /> � ��Q� ����.���Pl'�� <br /> ,, <br /> '� PHOPOSEDUSEOFBIT�LDING IHEFE6��.:ERTIFYTHF.I'IHAVEREADANDEaAMINEDTHISAPPLICATiONAND <br /> � S/v�/� �.p--. , �,i• KNOWTHESAMETOf3E7RUEANDCORRECT.ALIPROVISION50FLAWSAND <br /> �� LEGALOESGd✓TIONOfPROPE TV�SHOWNB OWORARpCNFOURCOFIES) ORDINANCESGOVERNINGTHISTYPEOFWORKWILLBECOAIPLETEDWITH <br /> + � � 7 WHETHEFSPECIFIEDHCREII•IOPNOT.THEGRANTINGOFAPEf7MITDOESNOT <br /> PRESUME TO GIVE AUTHORIT'f TO VIOLATE OR CANCEL'i HE PROVISIONS OF <br /> �� �oT�_ 6LOCH oF w .�u� ANYOTHERSTATEORLOCALLAWFEGUlA71NGCONSTRUCTIONORTHEPER� <br /> /A 7.f FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNEF7 OF <br /> �1 THIS FROPERN TO PERFORM THE WORK FOR WHICH ANPLICATION IS MADE <br /> — AND I COMPLY W�TH THE STATE CONTRACTORS Li�W iB27 flCW AND <br /> 296200 WAC. <br /> ,� SiGNAtUREOFCONTRPCtOROFAUiHOR12EDAGENT pATE a��%� �J <br /> � —r—�/ / i <br /> �� �--� � / <br /> .i PFOJEGTADDRES� � , ` ^ ` , ' <br /> /ti �_x� R\ � i � \ APPLICNNTSCItY6U O I NAME <br /> "�� / \ J`� , ;�r� w President, ros y �g��`��. <br /> c_.i�•��� <br /> �� PLUMBING MECHANICAL <br /> ti <br /> � NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCI.OSET(TOILET) — !VC—A/HNDLGUIvITS—H.P. <br /> [� BATHTU� FORCED AIR SYSTEMS—B.T.U. M EA <br /> �� LAVATORYpNASH8A51N) • UNITHEATERS—B.T.U. Id <br /> ;� SHOWER � CLOTHES DfiYERS <br /> ��� KITCHEN SINK 8 DISP. VENTILATION FAN <br /> �� <br /> DISHWASHER — RANGE HOOD <br /> LAUNQRYTRAY WATER HEATER <br /> CLOTHES WASHEfl _ � � WOOD STOVE ' <br /> c� URINAL METAL FlfiEPLACE 8 CHIMNEY <br /> � DRI4KING FOUNTAIN FIREPLACE INS[R7 <br /> � <br /> �,j FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PR�VENTERS GAS PIPING <br /> �! RCOFDRAINS—RAINLEADERS ERHAUSTFAN <br /> SINK(SERVIC[—BAR,ETC) � �� <br /> -- — ' <br /> SUBTOTAL $ — SUBTOTAL S <br /> � PERMIT 5 PERMIT S <br /> � TOTAL FEE S -- TOTAL FEE g �— <br /> , FRONTSEiB��,`� RERRSET6/CN SIpESEi�ACK PLpNtHECKNUMBEfl FEE flECEIPTNO. <br /> ?� e�v.r� z.o � .�' �� '� s'�°� �9 aa�g� aQd� GB a.s �s <br /> '. u5EII��NE �oTnnen vacnrvrsrt� PEES VALUATION FEE <br /> . ��I /(�z'2�� ❑YES ❑ NO <br /> �J � <br /> � TVPEOFCONST. OGGUPANGYGFOUP NOOFOWELUNOUHIiS BUILDIN6 �� `— <br /> � ALIOWABLE/ACTUA <br /> � � I PLUMBING � <br /> SIZEOFBLDO. NOAFSiOfiIES BSMi. OCG.LOA� <br /> � /7z 55r� R / p N N�A MECHANICAL _ '� <br /> I � A <br /> HEIGIITIIMIiATION OTHCR / U <br /> ' 28 ^ <br /> FIRESPRINKLEFSREOUIRE� ❑ YES O NO � <br /> j STATE B ILDING SURCHARGE <br /> � STATEENERGYSURCHARGE <br /> APPUCATIUN ACG BY PLRNSAPPR.UY <br /> �� ��� PUBLIC WOflKS <br /> TOTAL n <br /> 1 � � <br />